Utilization Review Specialist

ABHS • Evesham Township, NJ

3d • $55,000 - $65,000 • Onsite

About The Position

The Utilization Review Specialist processes all insurance authorizations for partial hospitalization programs, intensive outpatient programs and outpatient programs across business entities to ensure timely and appropriate services for clientele.

Requirements

• High School Diploma or equivalent education required
• At least 2 years working in behavioral health with exposure to insurance verification, billing, coding, diagnoses, and care management
• Experience working in an electronic medical records system.
• Computer literate: Microsoft Office (Excel, Word, and PowerPoint) required.
• Ability to manage conflicting priorities.
• Ability to maintain a positive work ethic and a congenial attitude in the face of a high-pressure environment.
• Ability to function independently and with flexibility.
• Ability to work under pressure, handle multiple tasks and interruptions.
• Ability to sit, stand, or walk for extended periods of time.

Nice To Haves

• Demonstrates ability to function effectively as a part of team.
• Uses outstanding oral and written communication with employees at all levels of the business for support and sharing of information.
• Take constructive feedback and prevent discourse among our peers.
• Critically thinking should be the solution when problems arise.
• Having the ability to accept constructive criticism well in an open and non-defensive manner.
• Wear business casual attire (please see dress code policy).
• Participates in educational training, orientations, or compliance programs as needed to maintain competency.
• If you must leave your employment with our company, we request employees to give us at least 14 days resignation notice in writing.

Responsibilities

• Handle the continuum of the utilization process for all ABHS entities.
• Outreach to insurance companies to gain authorizations for services such as TMS, partial hospitalization, intensive outpatient and outpatient programming.
• Maintain ongoing communication with the Patient Access Center, Billing Department, Clinical Department and Medical Department.
• Evaluate and assure adequacy of clinical information to screen for medical necessity.
• Consultation with internal Clinical and Medical staff regarding alternate services and clinical criteria.
• Administer appeal process for denials.
• Assists and covers other staff when necessary to maintain high productivity and efficiency in the department.
• As the company continues to grow, additional responsibilities that are essential for the department to be successful will be assigned accordingly.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED